Our Cancer Care Specialists
Dr. David Catalano is a graduate of Loma Linda University School of Medicine in California. He has been in practice for over 30 years. He received an American Cancer Society Fellowship Award in 1986. Dr. Catalano is board certified by the American Board of Radiology in radiation oncology, and is a Fellow of the American College of Radiation Oncology.
Dr. Calkins has been in practice for nearly 30 years. She has held several academic positions and served as the Medical Director of the Fred J. Woods Radiation Therapy Center at St. Joseph’s Hospital Cancer Institute in Tampa, FL. In addition to her role as Assistant Professor at USF Radiation Oncology, Tampa General Hospital, Dr. Calkins practices at ICCC on a part-time basis.
Our Cancer Care Technologies
Accelerated Partial-breast Irradiation (APBI)
Accelerated partial breast irradiation (APBI) is high-dose-rate (HDR) internal therapy for breast cancer, administered following a lumpectomy. There are several different applicators including SAVI®, Mammosite®, and Contura®. A radioactive Iridium-192 seed at the end of a metallic wire and contained within a computer-controlled HDR delivery system is directed to 50 or so pre-defined positions within a set of catheters, which are inserted into the lumpectomy site through plastic tubes or a balloon. The HDR delivery system directs the seed sequentially along each catheter tube, stopping at pre-defined dwell positions and delivering radiation along the length of the tube within the lumpectomy site and immediate surrounding area. Treatment is delivered twice a day over five treatment days. After each application, the radioactive seed is withdrawn from the tubes into a lead-lined box and the patient (now non-radioactive) can go home. After the ten treatments are completed, the balloon or catheter array is removed.
AccuBoost® is a non-invasive brachytherapy used for women with early-stage breast cancer. Light pressure from a mammography machine (much less than what is used during a mammogram) is used to immobilize the breast so that the radiation beams can be pointed directly at the targeted area from four perpendicular positions. The radiation is then delivered parallel to the chest wall, minimizing exposure to the heart, lungs, skin, and surrounding healthy tissues. Treatment with AccuBoost® is either once or twice a day for five days, or once a day for ten days, based on oncologist recommendation.
Calypso® 4D Localization System
The Calypso® treatment system finds and tracks the position of the prostate or lung tumor throughout radiation treatments. Since the prostate or lung tumor can move with breathing or the filling of the bladder or rectum, it is sometimes necessary to track organ or tumor movement in real-time and turn the radiation on and off depending upon whether the target is in the right place. The system works by implanting a tiny Calypso coil into the organ. The device is energized by an external magnetic field which causes the coil to send out a radio signal that can be located by the same external device that creates the magnetic field. This is similar to the GPS systems used in cars, but on a much more local scale. The process provides the ability to view the location and movement of the prostate or lung tumor. With this precise view of the location, adjustments can be made to the direction of the radiation beams during treatment, or the beam can be turned down if the radiation cannot track the tumor.
CT Scanning and Simulation
Computer Tomography (CT) Scanning & Simulation allows the cancer specialists to design a treatment plan specifically for the patient based on the size, location, and shape of the tumor. The patient will have three-dimensional images (CT Scans) taken. These are used with the treatment planning software that helps determine how to best deliver the radiation beams while reducing damage to surrounding areas. In some cases, it may be necessary to mark the patient’s skin with a tiny marker so that the patient is perfectly realigned in the correct position for every session of radiation therapy. The need for a temporary or permanent marker will be discussed with the patient before the simulation.
Freiburg Flap Procedure
The Freiburg flap applicator is used for high-dose-rate brachytherapy treatment for skin cancer. It is a flat, flexible, mat-like surface formed from small silicon spheres. A series of parallel plastic catheters are contained within the mat. The mat can be cut and shaped to lie directly upon the superficial tumor. The radiation is delivered through this mat and keeps the application uniform across the entire area being treated.
High Dose Rate Brachytherapy (HDR)
High-dose rate (HDR) brachytherapy delivers high-doses of radiation to the tumor area from within the body or on the surface of the skin. It is administered through an applicator tube or thin catheter that is inserted into the body or through an applicator that sits on top of the skin.
This process delivers radiation for several minutes to the specific area where the cancer is located, sparing surrounding tissue. The radiation is removed from the body, unlike low-dose brachytherapy which may stay implanted.
Image Guided Radiation Therapy (IGRT)
Image-Guided Radiation Therapy (IGRT) combines three-dimensional images, such as CT scans, with the precise technology of either 3-D or intensity-modulated radiation therapy (IMRT) to pinpoint and treat cancerous tumors. The images allow the cancer specialists to precisely localize the tumor each time radiation therapy is administered. This improves both accuracy of delivery and safety by reducing radiation exposure to other areas of the body including nearby tissue and organs. IGRT is used to treat tumors in areas of the body that are prone to movement, such as the lungs, liver, and prostate gland, as well as tumors located close to critical organs and tissues.
Intensity Modulated Radiation Therapy (IMRT)
Intensity-modulated radiation therapy (IMRT) is an advanced form of external radiation treatment that allows precise targeting of tumor cells. The CT simulator localization scan or other three-dimensional images provide the radiation oncologist with an understanding of the shape and location of the tumor. With 3D planning, the radiation oncologist specifies the dose from various beams and sums up those doses to calculate the dose to tumor and normal tissue (forward planning). With IMRT, the radiation oncologist specifies the dose desired to give the tumor and the doses acceptable to the normal tissues (as low as possible). Then the computer system provides millions of alternative beam positions and the varying intensities of each beam, comparing one plan to the next until the best plan is identified. This is called inverse planning. Since each beam is broken up into many sub-beams of varying intensity the process is called intensity-modulated radiation.
Seed Implants (Low Dose Rate Brachytherapy)
Low-dose rate (LDR) brachytherapy delivers radiation using a radioactive device or implant placed inside the body. The device delivers a low dose of radiation to a limited area over a period of 20 to 50 hours. It is one of the most focused, precise forms of radiation therapy and spares much of the surrounding tissue. LDR can be used to treat various cancer sites, such as prostate, uterus, or cervix.
Space OAR® Hydrogel
SpaceOAR® Hydrogel is used to protect the rectum from radiation exposure during prostate cancer treatment. It is a temporary, injectable gel that is placed between the prostate and rectum, acting as a spacer. It pushes the rectum away from the prostate, out of the area where radiation will be administered. SpaceOAR Hydrogel is injected as a liquid and solidifies into a soft, gel-like synthetic material that expands and creates the necessary space of about ½ to 1 cm. It is absorbed over three months and the prostate moves back to its original position.
Xofigo® (radium Ra 223 dichloride) is an injection of soluble radium that is processed by the body similarly to calcium and releases radiation to target and kill prostate cancer cells that have spread to bone. This treatment is commonly used to treat metastatic prostate cancer that no longer responds to chemotherapy or to hormonal or surgical treatments that lower testosterone.
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